Are there any important educational or medical needs we should know about your child?

Is your child currently on any medication?

Describe child’s previous Jewish education if any:

What benefits would you like to receive from our School?

Is your child Jewish? (required)

If converted or adopted, who performed the conversion? (required)

Language spoken at home (required)

Are you a member of a Synagogue? If yes, name of Synagogue (required)

Please provide contact information of someone (OTHER THAN A PARENT) that we can contact in case of emergency: (required)
Please enter Name, Relation, Phone (cell), Email, Family Physician, Physician Phone.

Do you have any friends who would be interested in this program?
Please enter name and phone number | You will receive $50 off your tuition for every child you referred that enrolls to the CBR Hebrew School